| NPI | 1518582188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 128421) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024179837) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024179837) | |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2022-05-15 |