| NPI | 1396017927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 87803) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: CA 773562) |
| 163W00000X Registered Nurse (Licence: GU RE2249) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: GU NP0166) | |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2017-04-30 |