| NPI | 1306223078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C003102) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R083778) |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2015-07-31 |