| NPI | 1164134763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 211278) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0113768) |
| Enumeration Date | 2022-12-15 |
| Last Update Date | 2023-02-01 |