| NPI | 1316609902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 12812621-4406) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2663) |
| Enumeration Date | 2021-10-11 |
| Last Update Date | 2024-01-30 |