| NPI | 1063181394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 224046) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN133150) |
| Enumeration Date | 2021-09-09 |
| Last Update Date | 2022-01-27 |