| NPI | 1861018830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 24011) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD AC004532) |
| 163W00000X Registered Nurse (Licence: SC 232266) | |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2022-07-12 |