| NPI | 1518645647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND 200917) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R39154) |
| Enumeration Date | 2023-07-10 |
| Last Update Date | 2025-02-19 |