| NPI | 1073686101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3010288) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 95262) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: ME 038976) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2016-05-25 |