| NPI | 1538144902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C002679) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN RN133006) |
| 163W00000X Registered Nurse (Licence: AR R079737) | |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2015-06-16 |