| NPI | 1669753265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 17683) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 103304) |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2024-03-25 |