| NPI | 1750426631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VT 101-0027388) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 058370-23) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2010-07-20 |