| NPI | 1285381806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024186293) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001272771) |
| Enumeration Date | 2022-03-03 |
| Last Update Date | 2023-04-04 |