| NPI | 1003426701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 69208) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL Rn9493739) |
| 163W00000X Registered Nurse (Licence: IN RN9493739) | |
| 163WS0200X Registered Nurse, School (Licence: FL RN9493739) | |
| Enumeration Date | 2020-08-06 |
| Last Update Date | 2022-02-17 |