| NPI | 1205681327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TN 238751) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 148849) |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2024-06-12 |