| NPI | 1639657844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024186530) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000194178) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 121451) | |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2023-03-15 |