| NPI | 1861851081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP08928) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN130632) |
| 163W00000X Registered Nurse (Licence: AR R095327) | |
| Enumeration Date | 2016-02-16 |
| Last Update Date | 2017-05-09 |