| NPI | 1629556170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 204632) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 118322) |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2021-11-30 |