| NPI | 1689239394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 126185) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 22901) |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2024-03-08 |