| NPI | 1972199636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3015634) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 216908) |
| Enumeration Date | 2020-12-17 |
| Last Update Date | 2021-02-22 |