| NPI | 1245702927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 221716) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 213671) |
| Enumeration Date | 2018-12-19 |
| Last Update Date | 2019-12-16 |