| NPI | 1649685579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9277331) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9277331) |
| 163W00000X Registered Nurse (Licence: PA 638472) | |
| 163W00000X Registered Nurse (Licence: NY 664129) | |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2014-11-16 |