| NPI | 1295280832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024174054) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD AC002244) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2023-12-08 |