| NPI | 1508252933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 12.006164) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 125598) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2018-04-26 |