| NPI | 1134511512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN.0993912) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD 99999999999999999999) |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2018-10-25 |