| NPI | 1073799060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 78470) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC APRN3461) |
| 163W00000X Registered Nurse (Licence: NC 244819) | |
| Enumeration Date | 2008-01-21 |
| Last Update Date | 2011-04-06 |