| NPI | 1790730943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP985972) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704104020) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 03992) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2015-12-07 |