| NPI | 1295151025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101254) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 5128498-4406) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 5128498-8901) | |
| Enumeration Date | 2014-03-18 |
| Last Update Date | 2014-11-18 |