| NPI | 1548937659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024190287) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 30197) |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2024-07-09 |