| NPI | 1174646566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN.0000569) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 79626) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2016-01-21 |