| NPI | 1063764744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 4321) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: VA 0001240453) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 091518) | |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2018-02-09 |