| NPI | 1851835300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 22170) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 112969) |
| Enumeration Date | 2016-12-16 |
| Last Update Date | 2022-03-16 |