| NPI | 1265819031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101328) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 64949) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2022-01-10 |