| NPI | 1568947810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5964) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 229358) |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2022-04-14 |