| NPI | 1972047413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2026) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 15722-33) |
| Enumeration Date | 2016-12-16 |
| Last Update Date | 2024-09-27 |