| NPI | 1386286805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 27019) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 227305) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4025380) | |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2024-08-29 |