| NPI | 1063495471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN134084) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA R134084) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2014-04-17 |