| NPI | 1922597087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 24813) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MS 894584) |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2018-10-30 |