| NPI | 1639106842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 01410) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA 038620) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2008-03-25 |