| NPI | 1023098142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 326) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 246857) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2009-10-13 |