| NPI | 1235795394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 108589) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R108589) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2020-11-02 |