| NPI | 1942274790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1083586) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 603393) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 3102) | |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2018-08-20 |