| NPI | 1265424998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN232083) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN086300 APO4390) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2013-07-17 |