| NPI | 1104574052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 7307) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 292371) |
| Enumeration Date | 2022-03-10 |
| Last Update Date | 2024-06-03 |