| NPI | 1124016415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C01434) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS A810403) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2019-08-19 |