| NPI | 1639328669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 193112) |
| Additional Taxonomies | 282NC0060X General Acute Care Hospital, Critical Access (Licence: NC CCNA 081859) |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2018-03-30 |