| NPI | 1063071397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 073064-21) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NH 073064-21) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VT 101-0134951) | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2022-04-26 |