| NPI | 1053379917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP3065242) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 155292) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: ME 050542) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 053324-23-11) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2011-05-30 |