| NPI | 1396853867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NC 118287) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 19616) |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2007-07-08 |