| NPI | 1114989480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 1642) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC apn 1642) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2010-11-11 |