| NPI | 1043983810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6832) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 307968) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024182621) | |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2023-05-06 |