| NPI | 1023332996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 375669-4406) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 725827) |
| Enumeration Date | 2010-03-22 |
| Last Update Date | 2021-12-21 |