| NPI | 1073590733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 200460004crna) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 89000337rn) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2013-03-22 |