| NPI | 1396700464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP04379) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA 078185) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2020-06-08 |