| NPI | 1275156275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 60541) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2010022663) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 60641) | |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2021-05-19 |