| NPI | 1811504590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D161940) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 9039506-3102) |
| Enumeration Date | 2020-09-28 |
| Last Update Date | 2021-02-17 |