| NPI | 1558757195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101320) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 105361) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2023-01-23 |