| NPI | 1568988640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 23673) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 225827) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: LA RN134160) | |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TX 868572) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 785429) | |
| Enumeration Date | 2017-08-20 |
| Last Update Date | 2020-12-22 |