| NPI | 1699507467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 313905) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV 817830) |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2025-01-28 |