| NPI | 1609351824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 218308) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN156470) |
| Enumeration Date | 2018-10-03 |
| Last Update Date | 2020-10-13 |