| NPI | 1568524262 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA 102247) | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN187781) | 
| Enumeration Date | 2006-12-16 | 
| Last Update Date | 2008-02-08 |