| NPI | 1104954551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101421) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: CO 713330) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2018-03-17 |