| NPI | 1821360652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD CR000788) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: SD R034213) |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2012-05-02 |