| NPI | 1912247297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-858A) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: VA RNA-858A) |
| Enumeration Date | 2013-02-22 |
| Last Update Date | 2023-03-07 |