| NPI | 1184957052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 178785) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 178785) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9476934) | |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2018-03-17 |