| NPI | 1427227875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9331689) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001175596) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024167864) | |
| Enumeration Date | 2008-02-29 |
| Last Update Date | 2011-10-03 |