| NPI | 1871160101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6656) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 136127) |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2021-06-08 |