| NPI | 1609985241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 24116782) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD AC000817) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2011-03-07 |