| NPI | 1962167056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO C-APN.0004574-C-CRNA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 838667) |
| 163W00000X Registered Nurse (Licence: OH 482550) | |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2022-09-21 |