| NPI | 1780141408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6488) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 261573) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 128551) | |
| Enumeration Date | 2019-02-28 |
| Last Update Date | 2021-07-09 |