| NPI | 1346721750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 123390) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 303962) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2018-10-08 |