| NPI | 1346613643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3012050) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TN 180058) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN20708) | |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2018-03-17 |