| NPI | 1407312382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 126321) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 232890) |
| Enumeration Date | 2019-02-15 |
| Last Update Date | 2020-12-09 |