| NPI | 1760758973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 89988) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 210668) |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2013-02-05 |