| NPI | 1568764173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AK 35187) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT 73185) |
| Enumeration Date | 2010-12-02 |
| Last Update Date | 2019-03-07 |