| NPI | 1639694086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 21339) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 0000185485) |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2024-06-10 |