| NPI | 1366823726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 108831) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 243357) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2015-10-28 |