| NPI | 1962178871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 35751) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN TBD) |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2024-03-07 |