| NPI | 1255331708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-092654) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1-092654) |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2010-02-22 |