| NPI | 1306484068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L6-0A10873) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN713085) |
| Enumeration Date | 2019-12-12 |
| Last Update Date | 2022-01-27 |