| NPI | 1912318585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 165001) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 19743) |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2025-02-04 |