| NPI | 1336110865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11004008) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 168679) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 13924) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 55704) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2022-04-29 |