| NPI | 1649904699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6969) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 28669) |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2024-08-16 |