| NPI | 1134659865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 106985) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000202800) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2019-07-19 |