| NPI | 1053083915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 37969) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 258230) |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2025-02-04 |