| NPI | 1093328460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 28884) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: TN 205314) |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2021-02-17 |