| NPI | 1851657738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 89071) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 144793-30) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2021-11-29 |