| NPI | 1538639984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60929524) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 895386) |
| 163W00000X Registered Nurse (Licence: OK 125367) | |
| Enumeration Date | 2018-11-28 |
| Last Update Date | 2019-11-14 |