| NPI | 1154913374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101649) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 68370) |
| Enumeration Date | 2021-02-09 |
| Last Update Date | 2021-10-15 |