| NPI | 1083931554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR CPT000139) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R66197) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2010-10-27 |