| NPI | 1639818602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3017833) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 137171) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2022-07-18 |