| NPI | 1114348034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R187500) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D179217) |
| 163W00000X Registered Nurse (Licence: VA 0001237305) | |
| Enumeration Date | 2013-12-18 |
| Last Update Date | 2024-08-20 |