| NPI | 1508006412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9180755) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 2258055) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 004013) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 798356) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 604947) | |
| Enumeration Date | 2009-03-05 |
| Last Update Date | 2011-05-23 |