| NPI | 1407495385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6302) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 279708) |
| Enumeration Date | 2019-12-25 |
| Last Update Date | 2023-01-19 |