| NPI | 1811382005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 19524) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 12345) |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2022-03-10 |