| NPI | 1316343916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 200522) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 200522 - 30) |
| Enumeration Date | 2014-11-08 |
| Last Update Date | 2024-04-11 |