| NPI | 1235874603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 26184) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: SC 256755) |
| Enumeration Date | 2022-05-01 |
| Last Update Date | 2024-05-15 |