| NPI | 1568105914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 275585) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IN 28245150A) |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2022-06-07 |