| NPI | 1912147638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 085330) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NE 56465) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 085330) | |
| 163W00000X Registered Nurse (Licence: CA 748618) | |
| Enumeration Date | 2009-02-21 |
| Last Update Date | 2012-05-27 |