| NPI | 1255655361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D-104324) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IA 104324) |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2010-06-15 |