| NPI | 1669709499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024-168679) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001129265) |
| Enumeration Date | 2009-11-16 |
| Last Update Date | 2010-03-09 |