| NPI | 1831616697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3014547) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 23174) |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2023-03-30 |