| NPI | 1740584572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024169892) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001235903) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 0102050) | |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2024-06-05 |