| NPI | 1265473078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9215859) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN326069L) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 2511) | |
| 163W00000X Registered Nurse (Licence: PA RN326069L) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2008-05-22 |