| NPI | 1306205877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 220375) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R086645) |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2022-10-24 |