| NPI | 1790301182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D159728) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 558211) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2024-10-11 |