| NPI | 1295519072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D176251) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 223057) |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2023-12-04 |