| NPI | 1790775302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN657548) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 624593) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2016-11-30 |