| NPI | 1275893604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0851) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 090051) |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2012-06-21 |