| NPI | 1134290794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 167110) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 1671100) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 050829) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2016-03-28 |