| NPI | 1205843273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 000179) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 000179) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2012-07-16 |