| NPI | 1356831077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704390608) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 121770) |
| Enumeration Date | 2018-05-17 |
| Last Update Date | 2023-08-14 |