| NPI | 1497298749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA 112937) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 7225531) |
| Enumeration Date | 2016-11-18 |
| Last Update Date | 2017-01-15 |