| NPI | 1427337161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2011032583) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 167039-030) |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2011-10-06 |