| NPI | 1942019005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024192516) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 153126) |
| Enumeration Date | 2025-01-03 |
| Last Update Date | 2025-02-27 |