| NPI | 1477690949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L6-0A00616) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DE L1-0040525) |
| 163W00000X Registered Nurse (Licence: SC 71167) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9308294) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2011-08-08 |