| NPI | 1477115491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 10039-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 194025-30) |
| Enumeration Date | 2019-06-29 |
| Last Update Date | 2020-12-02 |