| NPI | 1447885637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 006978) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 273120) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024188309) | |
| Enumeration Date | 2020-03-08 |
| Last Update Date | 2023-12-14 |