| NPI | 1366889552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 090770) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 207783) |
| 163W00000X Registered Nurse (Licence: WV 77680) | |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2014-01-16 |