| NPI | 1710559745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704345289) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ 193328) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 263500) | |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2024-02-15 |