| NPI | 1265784268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-120381) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1120381) |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2017-05-01 |