| NPI | 1124367537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 2283873) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY RN552608-1) |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2013-04-09 |