| NPI | 1780294199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN639064) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DE L1-0051674) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L6-0A10834) | |
| Enumeration Date | 2020-08-01 |
| Last Update Date | 2024-09-13 |