| NPI | 1558022616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 911910-30) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NM 66477) |
| Enumeration Date | 2021-12-31 |
| Last Update Date | 2024-12-03 |