| NPI | 1194119776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 006120) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 258410) |
| 163W00000X Registered Nurse (Licence: CT 125586) | |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2015-12-28 |