| NPI | 1538502877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 2057) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 189402) |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2013-06-24 |