| NPI | 1265907802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28257990A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 7321717-3102) |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2023-08-17 |