| NPI | 1376698464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 764-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 84985-030) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2011-09-13 |