| NPI | 1790198182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 21017) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 102263) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2022-07-21 |