| NPI | 1174876577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28206614A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71011097A) |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2022-10-06 |