| NPI | 1417579400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-144964) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 113288-23) |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2025-01-06 |