| NPI | 1902539174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D169869) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY D169869) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209025591) | |
| Enumeration Date | 2022-07-06 |
| Last Update Date | 2023-04-24 |