| NPI | 1689086837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 283089) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 6951) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2023-02-10 |