| NPI | 1871954115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5426) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 224473) |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2022-10-26 |