| NPI | 1033286752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 78444) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 265769) |
| 163W00000X Registered Nurse (Licence: VA 0001203310) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2021-03-18 |