| NPI | 1639402878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN062994) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1040907) |
| Enumeration Date | 2009-09-04 |
| Last Update Date | 2012-10-01 |