| NPI | 1619738333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT 238996) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 35507) |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2024-06-27 |