| NPI | 1225597305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WX0800X Registered Nurse Orthopedic (Licence: ID 62439) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 125895) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2022-09-14 |