| NPI | 1730724378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4032250) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11005753) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL 9266562) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP145995) | |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2024-12-18 |