| NPI | 1144550740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 285143) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 711768) |
| 163W00000X Registered Nurse (Licence: KS 13-91608-022) | |
| Enumeration Date | 2010-01-04 |
| Last Update Date | 2017-05-12 |