| NPI | 1053461889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024171123) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 157355) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 072157) | |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2013-08-28 |