| 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 |