| NPI | 1780174300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28209517A) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 122217) |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2023-11-21 |