| NPI | 1932774312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 68470) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 241081-30) |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2021-07-19 |