| NPI | 1760435895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN101742) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP04867) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2013-12-20 |