| NPI | 1902288053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN652148) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2024-06-11 |