| NPI | 1134884943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4032573) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 249632) |
| Enumeration Date | 2021-11-05 |
| Last Update Date | 2025-03-05 |