| NPI | 1427049709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 200174398) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO RN200174398) |
| 163W00000X Registered Nurse (Licence: TX RN530092) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2008-03-17 |