| NPI | 1770892978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 4372) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 199699) |
| Enumeration Date | 2010-10-05 |
| Last Update Date | 2015-01-15 |