| NPI | 1811688468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 293859) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 13-142607-012) |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2025-03-06 |