| NPI | 1841564739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 082997) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN581266) |
| 163W00000X Registered Nurse (Licence: NY 534450-1) | |
| 163W00000X Registered Nurse (Licence: TX 145116) | |
| 163W00000X Registered Nurse (Licence: NJ 26NR17106700) | |
| 163W00000X Registered Nurse (Licence: NJ 26NJ00493200) | |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2015-03-09 |