| NPI | 1912485467 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP10014) | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 10012636) | 
| Enumeration Date | 2018-08-06 | 
| Last Update Date | 2023-09-14 |