| NPI | 1568021046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN.0994868) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.1661187) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2020-02-04 |