| NPI | 1124893771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 7531) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 286901) |
| Enumeration Date | 2023-11-22 |
| Last Update Date | 2024-08-26 |