| NPI | 1639684699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 1494) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 6566569-3102) |
| Enumeration Date | 2017-12-12 |
| Last Update Date | 2018-07-10 |