| NPI | 1407355464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 226885) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN176078) |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2023-10-20 |