| NPI | 1710523659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 29548) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R202526) |
| Enumeration Date | 2019-11-26 |
| Last Update Date | 2024-11-14 |