| NPI | 1497021935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP06778) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9341335) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28218373A) | |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2016-04-26 |