| NPI | 1154945830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 60520) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R234862) |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2020-07-08 |