| NPI | 1659963510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN564464) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3018883) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA PA564464) | |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2023-06-13 |