| NPI | 1225105943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD CR000251) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SD CR000251) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2023-06-09 |