| NPI | 1295313286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704285674) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: MI 4704285674) |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2021-06-30 |