| NPI | 1548937733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3017160) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 237416) |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2022-04-01 |