| NPI | 1750127015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR 230421) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R103213) |
| Enumeration Date | 2024-07-06 |
| Last Update Date | 2024-11-22 |