| NPI | 1194325076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 251520) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN217218) |
| Enumeration Date | 2020-10-29 |
| Last Update Date | 2021-02-01 |