| NPI | 1598283293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5731) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 119050) |
| Enumeration Date | 2017-09-01 |
| Last Update Date | 2025-04-16 |