| NPI | 1265417182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R146328) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R146328) |
| 163W00000X Registered Nurse (Licence: AK 25231) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN202515) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2021-01-12 |