| NPI | 1861958852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2019010875) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2013018468) |
| Enumeration Date | 2019-02-14 |
| Last Update Date | 2022-09-12 |