| NPI | 1215317557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 107514) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 258972) |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2015-06-03 |