| NPI | 1003823733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024-089932) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001-089932) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2008-05-05 |