| NPI | 1710550686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 14168) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 176041) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 717981) | |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2024-11-28 |