| NPI | 1033573902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 245839) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 245839) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 5417) | |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2018-05-16 |