| NPI | 1043986961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 147150) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000228440) |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2024-02-08 |