| NPI | 1134151186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: LA RN070478) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA APO2815) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2008-02-15 |