| NPI | 1215120746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 2368) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 407940) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2007-08-17 |