| NPI | 1942772744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN714340) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001254225) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: DC 124687) | |
| Enumeration Date | 2018-12-19 |
| Last Update Date | 2024-05-08 |