| NPI | 1871945345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP08890) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 117545) |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2022-06-28 |