| NPI | 1639643075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704304021) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 125160) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11001696) | |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2022-05-09 |