| NPI | 1851392526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA R095261) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC R78943) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 237104) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2015-02-05 |