| NPI | 1700240561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 202008290CRNA-PP) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 38204) |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2021-10-20 |