| NPI | 1972065522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61057093) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO C-APN.0001558-C-CRNA) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2021-01-08 |