| NPI | 1518160340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 075697) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN-352827-L) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2013-03-25 |