| NPI | 1780191734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000846) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5800) |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2021-08-13 |