| NPI | 1912598384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024189409) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN280108) |
| 163W00000X Registered Nurse (Licence: PA TLRN061816) | |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2024-06-24 |