| NPI | 1043262934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MT 19063) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55450) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2023-01-24 |