| NPI | 1396485058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2022021644) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2013026380) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2022-07-12 |