| NPI | 1740260108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 075254) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2001015666) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2015-10-07 |