| NPI | 1487300513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 138684) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 23538530) |
| Enumeration Date | 2022-02-28 |
| Last Update Date | 2022-06-02 |