| NPI | 1235461492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024168680) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001214870) |
| Enumeration Date | 2010-02-12 |
| Last Update Date | 2011-09-22 |