| NPI | 1639513765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2284335) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN2284335) |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2013-07-05 |