| NPI | 1033773593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 226730) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN136074) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AR 120488) | |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2022-10-07 |