| NPI | 1649361288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 072163) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 147429) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2013-11-04 |