| NPI | 1417465295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 62075144406) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 6201556-3102) |
| 163W00000X Registered Nurse (Licence: FL RN9407699) | |
| 163W00000X Registered Nurse (Licence: VA 0001277405) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024175977) | |
| Enumeration Date | 2018-01-16 |
| Last Update Date | 2021-07-20 |