| NPI | 1467921015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024194514) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN680297) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN680297) | |
| 163WG0000X Registered Nurse, General Practice (Licence: PA RN680297) | |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2026-02-10 |