| NPI | 1659097145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 13709) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 191982) |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2023-03-17 |