| NPI | 1801331863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 29572) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 249110) |
| Enumeration Date | 2016-12-30 |
| Last Update Date | 2025-01-02 |