| NPI | 1639776776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN0000031068) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 291742) |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2022-02-14 |