| NPI | 1720362999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9328944) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 667490) |
| 163W00000X Registered Nurse (Licence: FL 9328944) | |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2011-12-13 |