| NPI | 1790433241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 116446) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.522332) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11033120) | |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2024-06-27 |