| NPI | 1629072582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: VA 0001153014) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 153014) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2007-07-08 |