| NPI | 1275868614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 3839) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OK 97147) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 678805) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 97147) | |
| Enumeration Date | 2009-10-02 |
| Last Update Date | 2022-02-11 |