| NPI | 1053763326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024173768) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001207630) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2019-02-01 |