| NPI | 1225452162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2014011359) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2005021478) |
| Enumeration Date | 2014-02-12 |
| Last Update Date | 2014-04-24 |