| NPI | 1639877186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024186822) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 143717) |
| Enumeration Date | 2023-02-22 |
| Last Update Date | 2024-12-16 |