| NPI | 1700875390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK 196) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 83422-030) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2009-08-05 |