| NPI | 1215345137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 19201) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 114100) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2022-03-06 |