| NPI | 1659315463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-038062) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-038062) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2010-11-05 |