| NPI | 1053965160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 215771) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000193687) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN26568) | |
| Enumeration Date | 2019-07-26 |
| Last Update Date | 2024-09-24 |