| NPI | 1336868140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024185176) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001312983) |
| Enumeration Date | 2022-08-24 |
| Last Update Date | 2022-09-10 |