| NPI | 1639501695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024171087) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000168890) |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2013-10-17 |