| NPI | 1104814516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024166429) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001154508) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2018-01-12 |