| NPI | 1104421213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 29061) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 215987) |
| Enumeration Date | 2020-12-04 |
| Last Update Date | 2023-11-09 |