| NPI | 1992123582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD CR000918) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: SD R036618) |
| 207L00000X Anesthesiology (Licence: NE 101240) | |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2022-04-18 |