| NPI | 1376747873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C002670) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR CTP000049) |
| 163W00000X Registered Nurse (Licence: AR R069818) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2017-01-25 |