| NPI | 1598355505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN669712) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 770177) |
| 163W00000X Registered Nurse (Licence: TX 841841) | |
| Enumeration Date | 2021-01-23 |
| Last Update Date | 2023-07-24 |