| NPI | 1134491160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101182) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 64373) |
| Enumeration Date | 2012-02-07 |
| Last Update Date | 2012-03-15 |