| NPI | 1720646136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11005724) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: FL 9483758) |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2020-02-20 |