| NPI | 1356600761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD CR000786) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SD R041264) |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2017-03-10 |