| NPI | 1922691708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 29663) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R104492) |
| Enumeration Date | 2021-02-12 |
| Last Update Date | 2021-06-22 |