| NPI | 1386020873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 108811) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 231817) |
| Enumeration Date | 2015-08-06 |
| Last Update Date | 2015-11-11 |