| NPI | 1801364401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 327603) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 140704) |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2025-08-13 |