| NPI | 1114261567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 91548) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN-589691) |
| Enumeration Date | 2012-11-23 |
| Last Update Date | 2013-03-25 |