| NPI | 1699318352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11006126) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9331092) |
| Enumeration Date | 2019-10-24 |
| Last Update Date | 2020-02-18 |