| NPI | 1376221655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND 201207) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R38628) |
| Enumeration Date | 2023-07-07 |
| Last Update Date | 2024-10-31 |