| NPI | 1720319528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024169026) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9308821) |
| 163W00000X Registered Nurse (Licence: VA 0001227192) | |
| Enumeration Date | 2010-01-19 |
| Last Update Date | 2014-08-12 |