| NPI | 1588390280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2022029132) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-558341) |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2025-11-20 |