| NPI | 1720588015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1525) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R101853) |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2019-02-12 |