| NPI | 1649803172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 9639260-4406) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9469329) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024179084) | |
| Enumeration Date | 2020-02-12 |
| Last Update Date | 2023-08-24 |