| NPI | 1144274887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R203872) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 63439) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN282715L) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2019-02-01 |