| NPI | 1346526316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 100078) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 164670) |
| Enumeration Date | 2011-10-22 |
| Last Update Date | 2012-01-06 |