| NPI | 1699778803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-048920) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 070708-1568) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN196015) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2019-05-09 |