| NPI | 1508371352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 24379) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MS 891288) |
| Enumeration Date | 2017-12-01 |
| Last Update Date | 2018-07-10 |