| NPI | 1346810835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024184535) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 870107) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2023-03-03 |