| NPI | 1730849308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN782212) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 207409) |
| Enumeration Date | 2021-12-23 |
| Last Update Date | 2023-12-03 |