| NPI | 1366114324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TN 203568) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV 882445) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NV 882445) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 37931) | |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2025-02-04 |