| NPI | 1053742759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101236) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 69294) |
| Enumeration Date | 2013-12-05 |
| Last Update Date | 2014-12-08 |