| NPI | 1215344874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 0000) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 218337) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2023-06-29 |