| NPI | 1144857756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11007013) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: FL 9380826) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2020-05-04 |