| NPI | 1558515940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA-01352) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA 270506) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2015-02-23 |