| NPI | 1376678995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP30007636) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 125879) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2007-07-08 |