| NPI | 1770250334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 901753) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS 901739) |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2021-12-30 |