| NPI | 1982271870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 7188) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: SC 259536) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2024-11-15 |