| NPI | 1962980482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA1556) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: UT 9417194-3102) |
| 163W00000X Registered Nurse (Licence: UT 9417194-3102) | |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2018-09-17 |