| NPI | 1972096733 |
|---|---|
| Other Name | N/A N/A N/A |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 117738) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2011011036) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2024-07-10 |