| NPI | 1659909422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GU NP0232) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 437936) |
| 163W00000X Registered Nurse (Licence: GU RX0578) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 0020120) | |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2021-08-03 |