| NPI | 1932877735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WY 49074) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 7054837-3102) |
| Enumeration Date | 2021-09-06 |
| Last Update Date | 2022-01-03 |