| NPI | 1487873337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 0001300) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN 77277) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2016-08-30 |