| NPI | 1457918658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 26035) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R094723) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2019-07-24 |