| NPI | 1114989779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NV CRNA000436) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 162001) |
| 163W00000X Registered Nurse (Licence: NV RN77203) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2015-01-15 |