| NPI | 1912397969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 323628) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK 448) |
| Enumeration Date | 2015-01-29 |
| Last Update Date | 2025-06-05 |