| NPI | 1104867894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-076304) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-076304) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2010-11-05 |