| NPI | 1144837493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 9244) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 170803) |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2022-08-14 |