| NPI | 1932650181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 260296) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 106355) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28232939A) | |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2024-06-13 |