| NPI | 1043276355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024-166043) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001-168448) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2008-05-08 |