| NPI | 1366112120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 268241) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0098706) |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2022-06-29 |