| NPI | 1851909626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NC 271503) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC Pending) |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2020-10-27 |