| NPI | 1508552613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 214097) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95192561) |
| 163W00000X Registered Nurse (Licence: OK R0110775) | |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2023-07-28 |