| NPI | 1114313491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 19482) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 103550) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2016-07-12 |