| NPI | 1932768801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 123428) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN134258) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN134258) | |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2021-06-17 |