| NPI | 1669917274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 24041) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5592) |
| Enumeration Date | 2017-01-05 |
| Last Update Date | 2024-04-30 |