| NPI | 1154719722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 255774) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NC 255774) |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2015-03-30 |