| NPI | 1316247117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN112300-AP06372) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA 112300) |
| Enumeration Date | 2010-10-26 |
| Last Update Date | 2011-02-02 |