| NPI | 1639727878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 26540) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN203726) |
| Enumeration Date | 2019-08-30 |
| Last Update Date | 2019-12-26 |