| NPI | 1366788796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C002943) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK R0102067) |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2013-01-04 |