| NPI | 1659850741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NC 229161) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 006035) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 220638) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 29606A) | |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2024-11-07 |