| NPI | 1588325179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704304563) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 121531) |
| Enumeration Date | 2022-01-05 |
| Last Update Date | 2023-04-29 |