| NPI | 1659827129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP09044) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000194163) |
| 163W00000X Registered Nurse (Licence: LA 131855) | |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2018-01-29 |