| NPI | 1053556563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C02727 CRNA) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R70975) |
| Enumeration Date | 2008-12-11 |
| Last Update Date | 2009-03-31 |