| NPI | 1649728981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 285173) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704324213) |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2024-04-11 |