| NPI | 1053325464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C00464) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R28690) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2008-09-15 |