| NPI | 1720750409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6811) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 288157) |
| Enumeration Date | 2021-10-01 |
| Last Update Date | 2022-04-21 |