| NPI | 1528428125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C003143) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R081215) |
| Enumeration Date | 2016-02-25 |
| Last Update Date | 2022-01-04 |