| NPI | 1316628563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 1811497) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95105960) |
| 207L00000X Anesthesiology (Licence: CA 95002220) | |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2024-10-14 |