| NPI | 1316330350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R35279) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 79413) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101295) | |
| Enumeration Date | 2015-03-16 |
| Last Update Date | 2022-12-19 |