| NPI | 1639815277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 276446) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ 296446) |
| 163W00000X Registered Nurse (Licence: SD R047301) | |
| Enumeration Date | 2022-05-06 |
| Last Update Date | 2024-07-24 |