| NPI | 1730684176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R54023) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SD R041434) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D150890) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2023-05-10 |