| NPI | 1164784310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201260049CRNA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201240512RN) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2012-09-26 |