| NPI | 1710316773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 100943) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SD R038213) |
| Enumeration Date | 2013-11-10 |
| Last Update Date | 2014-10-03 |