| NPI | 1285208231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 29607) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 100951) |
| 163W00000X Registered Nurse (Licence: TN 250270) | |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2023-10-20 |