| NPI | 1306586698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3017780) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 93493) |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2022-05-16 |