| NPI | 1699318188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN662891) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 130150) |
| Enumeration Date | 2019-10-28 |
| Last Update Date | 2021-12-07 |