| NPI | 1811546559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2019034633) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D164053) |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2024-09-25 |