| NPI | 1114583564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28199938A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28199938A) |
| Enumeration Date | 2019-05-10 |
| Last Update Date | 2023-06-20 |