| NPI | 1255897336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3015642) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 126328) |
| 163W00000X Registered Nurse (Licence: NC 291825) | |
| Enumeration Date | 2019-02-14 |
| Last Update Date | 2021-02-05 |