| NPI | 1245598671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 0948) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ 179809) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2015-01-20 |