| NPI | 1164930780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024175800) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN637480) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 120745) | |
| Enumeration Date | 2018-01-17 |
| Last Update Date | 2018-02-01 |