| NPI | 1649868084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2868) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61117369) |
| Enumeration Date | 2020-12-31 |
| Last Update Date | 2023-08-25 |