| NPI | 1932853066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11019598) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9391730) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 36070) | |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2025-02-17 |