| NPI | 1245585405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C002934) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R81788) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 16912) | |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2021-03-20 |