| NPI | 1184634644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP04882) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN089101) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 102156) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2024-10-29 |