| NPI | 1184607285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 24179395) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 202201644RN) |
| 163W00000X Registered Nurse (Licence: KS 14-153121-072) | |
| 163W00000X Registered Nurse (Licence: VA 0001186892) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-557812-072) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2022-02-16 |