| NPI | 1255319612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 036548) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 211206) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2012-10-04 |