| NPI | 1932792751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 134304) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 111961-23) |
| Enumeration Date | 2021-02-12 |
| Last Update Date | 2024-09-11 |