| NPI | 1477107613 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 127841) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ RN183431) |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2022-02-13 |