| NPI | 1710494687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024175752) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 118744) |
| Enumeration Date | 2018-01-02 |
| Last Update Date | 2022-08-09 |