| NPI | 1275202103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 31006) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9411783) |
| Enumeration Date | 2021-09-13 |
| Last Update Date | 2022-03-29 |