| NPI | 1164191144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 30987) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 205185) |
| Enumeration Date | 2021-09-13 |
| Last Update Date | 2023-10-12 |