| NPI | 1588265417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 28815) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 198212) |
| Enumeration Date | 2020-11-06 |
| Last Update Date | 2021-01-18 |