| NPI | 1306507819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 31005) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000223291) |
| Enumeration Date | 2022-01-06 |
| Last Update Date | 2025-02-04 |