| NPI | 1700456886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 66578) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM RN-69306) |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2024-02-01 |