| NPI | 1730153446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9228977) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT E55174) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2013-01-11 |