| NPI | 1174218184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 12188) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 210889) |
| 163WG0000X Registered Nurse, General Practice (Licence: FL 9464145) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11027334) | |
| Enumeration Date | 2023-04-06 |
| Last Update Date | 2023-08-22 |