| NPI | 1386107340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3016701) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 25785) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2025-03-19 |