| NPI | 1114320546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R213012) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R213012) |
| 163W00000X Registered Nurse (Licence: FL rn9230091) | |
| 163W00000X Registered Nurse (Licence: NY 592452-1) | |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2015-06-19 |