| NPI | 1285101634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 22347) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 76913) |
| Enumeration Date | 2018-10-24 |
| Last Update Date | 2024-04-10 |