| NPI | 1851879316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP10152) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 61773) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 118323) | |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2022-01-25 |