| NPI | 1689750473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C01305) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R52454) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2017-01-12 |