| NPI | 1699522748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2024021476) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2021009510) |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2024-07-15 |