| NPI | 1619483658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TN 217268) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 901521) |
| Enumeration Date | 2017-12-27 |
| Last Update Date | 2024-07-17 |