| NPI | 1841947892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001713) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 102249) |
| Enumeration Date | 2022-03-08 |
| Last Update Date | 2024-11-04 |