| NPI | 1609451756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 10679) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 135691) |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2022-07-11 |