| NPI | 1992045660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024186445) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 211511) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 18289) | |
| Enumeration Date | 2013-02-18 |
| Last Update Date | 2024-06-06 |