| NPI | 1467444885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 053776) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 122324) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2020-10-27 |