| NPI | 1073009536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 119994) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-126445) |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2018-08-13 |