| NPI | 1801550694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR 217811) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2015024352) |
| Enumeration Date | 2021-10-27 |
| Last Update Date | 2021-10-27 |