| NPI | 1750975884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6613) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 303244) |
| Enumeration Date | 2021-03-01 |
| Last Update Date | 2023-05-24 |