| NPI | 1134842172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK 199497) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AK 197941) |
| 163W00000X Registered Nurse (Licence: OH 439888) | |
| Enumeration Date | 2022-09-23 |
| Last Update Date | 2022-10-11 |