| NPI | 1477003069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 90732) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK 90832) |
| Enumeration Date | 2016-10-07 |
| Last Update Date | 2017-03-08 |