| NPI | 1366866949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1099421) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 2290823) |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2014-02-18 |