| NPI | 1093176232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: SD SD-RNR036473) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD CR000911) |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2016-04-01 |