| NPI | 1386317642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6696) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 294376) |
| Enumeration Date | 2021-07-31 |
| Last Update Date | 2021-09-07 |