| NPI | 1386782571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9277167) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 681113) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 77866) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2016-03-09 |