| NPI | 1124475413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 21366) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 184193) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2016-08-04 |