| NPI | 1740542364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 17889) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 89904) |
| Enumeration Date | 2012-06-10 |
| Last Update Date | 2023-09-05 |