| NPI | 1114213501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 597211) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 597211) |
| 163W00000X Registered Nurse (Licence: CT 088571) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2012-07-17 |