| NPI | 1689385411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1179194) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-558047-041) |
| Enumeration Date | 2022-12-13 |
| Last Update Date | 2025-01-27 |