| NPI | 1225311038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 19267) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 55240) |
| Enumeration Date | 2011-09-28 |
| Last Update Date | 2016-05-31 |