| NPI | 1336447937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024169440) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 204063) |
| 163W00000X Registered Nurse (Licence: GA 163028) | |
| Enumeration Date | 2011-03-05 |
| Last Update Date | 2011-07-22 |