| NPI | 1508806183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9275240) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 1055329) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9275240) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2010-02-22 |