| NPI | 1730702861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 28067) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 899425) |
| Enumeration Date | 2020-05-23 |
| Last Update Date | 2020-08-31 |