| NPI | 1659943017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 31214) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28286737A) |
| 163W00000X Registered Nurse (Licence: OH RN.416878) | |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2024-02-23 |