| NPI | 1407580228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 0004656-C-CRNA) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: WI 230813-30) |
| 207L00000X Anesthesiology (Licence: WI 230813-30) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 125184) | |
| Enumeration Date | 2022-07-16 |
| Last Update Date | 2024-11-27 |