| NPI | 1518540129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024181620) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001291345) |
| Enumeration Date | 2021-05-02 |
| Last Update Date | 2024-07-23 |