| NPI | 1700349685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 22889) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 214107) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2022-02-25 |