| NPI | 1073795985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA-866A) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 160305) |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2017-11-06 |