| NPI | 1104301878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: RI RN57307) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1029364) |
| Enumeration Date | 2018-09-28 |
| Last Update Date | 2024-04-10 |