| NPI | 1699416677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WY 50297) |
| Additional Taxonomies | 163WP0200X Registered Nurse Pediatrics (Licence: WI 250070-30) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2022-08-23 |