| NPI | 1962994756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024176254) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001267770) |
| 163W00000X Registered Nurse (Licence: FL RN9351506) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D177329) | |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2024-06-03 |