| NPI | 1225674658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3017302) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001274617) |
| 163W00000X Registered Nurse (Licence: PA RN717602) | |
| Enumeration Date | 2019-11-20 |
| Last Update Date | 2022-02-02 |