| NPI | 1891288783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2018020174) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 239533) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2021-07-01 |