| NPI | 1194040337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 15036) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS R369558) |
| Enumeration Date | 2010-03-31 |
| Last Update Date | 2011-06-09 |