| NPI | 1942248125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201801101CRNA) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN631023) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209-05581) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2019-05-06 |