| NPI | 1912361635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557425) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R097997) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2017-02-21 |