| NPI | 1396096921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 5250) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 91681) |
| 163W00000X Registered Nurse (Licence: NY 598579) | |
| Enumeration Date | 2012-09-22 |
| Last Update Date | 2021-04-16 |