| NPI | 1467763953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 085568) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 227251) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2012-07-23 |