| NPI | 1871146381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6376) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: NC 232733) |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2020-06-03 |