| NPI | 1740876200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 857349) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 69020) |
| 163WS0200X Registered Nurse, School (Licence: TX 872325) | |
| Enumeration Date | 2020-12-17 |
| Last Update Date | 2022-12-29 |