| NPI | 1407419278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR 121151) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R095402) |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2021-11-12 |