| NPI | 1710646062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 206396) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0118941) |
| Enumeration Date | 2021-12-14 |
| Last Update Date | 2022-04-29 |