| NPI | 1972917987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-908A) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: WA RN60263810) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2022-03-02 |