| NPI | 1134728512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 29631) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS 905711) |
| Enumeration Date | 2020-10-18 |
| Last Update Date | 2021-06-15 |