| NPI | 1982058426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 111035) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 217738) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024183039) | |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2022-04-08 |