| NPI | 1578617833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 077332) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-095859) |
| 163W00000X Registered Nurse (Licence: NC 235936) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2012-09-17 |