| NPI | 1023507852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 901522) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS 885346) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 24760) | |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2024-03-27 |