| NPI | 1518266196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2020039161) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 186023) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2023-10-09 |