| NPI | 1063583755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 029445) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 053655) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2012-07-20 |