| NPI | 1912500745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 202211571CRNA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 5494787-3102) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NC 310189) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6543) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 0000000-0000) | |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2022-10-28 |