| NPI | 1154384642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024D78877) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001078877) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2013-12-09 |