| NPI | 1689295651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 9102) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 146937) |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2020-09-02 |