| NPI | 1205005204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 0091029) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SD R032031) |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2008-02-22 |