| NPI | 1336890359 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 223878) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 16221) |
| Enumeration Date | 2022-01-11 |
| Last Update Date | 2025-02-14 |