| NPI | 1194721159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 44766) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OK R0044766) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2020-01-30 |