| NPI | 1649286444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: SD R030901) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD R030901/0452) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-08 |