| NPI | 1073878724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 184230) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 171872-30) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2018-06-01 |