| NPI | 1588108328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 22180) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN000177585) |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2017-07-19 |