| NPI | 1093701401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C00745) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R37449) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2008-03-27 |