| NPI | 1922604925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL 11010859) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11010859) |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2021-11-14 |