| NPI | 1508216722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP61055260) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 636577-1) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 636577) | |
| Enumeration Date | 2016-06-18 |
| Last Update Date | 2024-04-01 |