| NPI | 1497228134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA 124626) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN239390) |
| Enumeration Date | 2019-01-04 |
| Last Update Date | 2020-04-02 |