| NPI | 1760721765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK 35150) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 728851) |
| 163W00000X Registered Nurse (Licence: TX 811563) | |
| 163W00000X Registered Nurse (Licence: AK 35150) | |
| Enumeration Date | 2013-02-11 |
| Last Update Date | 2014-01-13 |