| NPI | 1457987372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 129174) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2012005622) |
| 163W00000X Registered Nurse (Licence: VA 0001298382) | |
| 363L00000X Nurse Practitioner (Licence: VA 0024179470) | |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2023-03-27 |