| NPI | 1295363315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 226194) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 10009694) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2024-05-15 |