| NPI | 1144796483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 005979) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 229105) |
| Enumeration Date | 2018-10-14 |
| Last Update Date | 2022-11-22 |