| NPI | 1982336731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 212189) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR 222019) |
| 163W00000X Registered Nurse (Licence: OK R111473) | |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2025-01-29 |