| NPI | 1740857119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: SC 254424) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R54336) |
| Enumeration Date | 2021-06-05 |
| Last Update Date | 2025-04-28 |