| NPI | 1609234335 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 346201-4406) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 346201-3102) |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2016-02-10 |