| NPI | 1396298121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2017001831) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2011031944) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 27862) | |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2024-02-14 |