| NPI | 1417645367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4015652) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 265596) |
| Enumeration Date | 2023-04-28 |
| Last Update Date | 2024-03-06 |