| NPI | 1790071041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9267084) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9267084) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2011-07-22 |