| NPI | 1417966953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 073396) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 172062) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2015-04-10 |