| NPI | 1558613760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 5209) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 75251) |
| Enumeration Date | 2012-10-11 |
| Last Update Date | 2013-09-30 |