| NPI | 1972049377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA 208072) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA RN208072) |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2024-10-07 |