| NPI | 1164522348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN232702L) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 35292) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 2885) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |