| NPI | 1306308333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 138317) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 873961) |
| 163W00000X Registered Nurse (Licence: AZ 242973) | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2022-06-21 |