| NPI | 1629665997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704307078) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4704307078) |
| Enumeration Date | 2020-12-21 |
| Last Update Date | 2020-12-21 |