| NPI | 1598083206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 84759) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 189773) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2013-05-06 |