| NPI | 1730888769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11037059) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001281520) |
| Enumeration Date | 2023-02-28 |
| Last Update Date | 2025-01-09 |