| NPI | 1316416100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 244697) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 244697-30) |
| Enumeration Date | 2018-11-21 |
| Last Update Date | 2023-03-06 |