| NPI | 1861980021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 12419763-4406) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR 121901) |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2021-08-31 |