| NPI | 1033379698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 082585) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 632875) |
| 163W00000X Registered Nurse (Licence: CA 632875) | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2010-02-10 |