| NPI | 1215205463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0825) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R188877-1) |
| 163W00000X Registered Nurse (Licence: AZ RN148370) | |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2012-03-01 |