| NPI | 1134218969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 3079) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 489087) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2010-10-01 |