| NPI | 1700415957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 23919) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 205747) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2023-11-27 |