| NPI | 1265037741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WY 47281) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 6382424-3102) |
| Enumeration Date | 2020-12-02 |
| Last Update Date | 2022-03-08 |