| NPI | 1275792665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C02704) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R65096) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AR CTP000076) | |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2009-03-17 |