| NPI | 1992831689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R135040) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 23373) |
| 163W00000X Registered Nurse (Licence: IN 28232191A) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2017-01-23 |