| NPI | 1104207273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C003107) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R073684) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2020-03-27 |