| NPI | 1679201420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN716209) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA XXXXXXX) |
| Enumeration Date | 2022-08-10 |
| Last Update Date | 2022-12-17 |