| NPI | 1033700497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 30330) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 208477) |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2021-10-01 |