| NPI | 1487333415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4014659) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9427200) |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2024-02-16 |