| NPI | 1053879676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD CR001007) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SD R040411) |
| Enumeration Date | 2019-03-04 |
| Last Update Date | 2019-03-27 |