| NPI | 1659313864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-031210) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-031210) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2010-11-04 |