| NPI | 1376951681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024171948) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001224329) |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2014-08-14 |