| NPI | 1295219996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 10026) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2268) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 123482) | |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2021-03-04 |