| NPI | 1700377751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 14740) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 283703) |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2024-05-30 |