| NPI | 1093258386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 112038) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ID 41135) |
| Enumeration Date | 2016-11-18 |
| Last Update Date | 2024-09-13 |