| NPI | 1629790647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO C-APN.0100302-C-CRNA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 10197649-3102) |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2023-01-10 |