| NPI | 1982050852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 11333) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 257263) |
| Enumeration Date | 2016-05-10 |
| Last Update Date | 2022-01-25 |