| NPI | 1669410189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN.0004199) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 235382) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 235382) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024166963) | |
| 163W00000X Registered Nurse (Licence: VA 0001200777) | |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2016-09-02 |