| NPI | 1114438488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 113047) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MN 2014007) |
| Enumeration Date | 2017-10-13 |
| Last Update Date | 2018-03-17 |