| NPI | 1477941755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 59454) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 19532) |
| 163W00000X Registered Nurse (Licence: TN 0000165025) | |
| Enumeration Date | 2015-01-08 |
| Last Update Date | 2023-09-29 |