| NPI | 1316454002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA 222836) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 25200) |
| Enumeration Date | 2018-01-04 |
| Last Update Date | 2023-12-14 |