| NPI | 1215578422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK 154366) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: AK 100357) |
| Enumeration Date | 2019-09-30 |
| Last Update Date | 2022-12-21 |