| NPI | 1366709156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000088) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA RN2260081) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2260081) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2014-05-20 |