| NPI | 1407366701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 8225) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 180222) |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2024-07-18 |