| NPI | 1295731081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 6429) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000006429) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024162111) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3007055) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1659) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 12386-NA) | |
| Enumeration Date | 2005-06-26 |
| Last Update Date | 2011-10-04 |