| NPI | 1326628280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 0002941) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SD R045161) |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2021-05-19 |