| NPI | 1124459680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 125330) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R088752) |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2018-07-27 |