| NPI | 1972083400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 125894) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV 834775) |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2021-04-06 |