| NPI | 1609377175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9486666) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WV 86127) |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2022-09-13 |