| NPI | 1780683821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024166414) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001150060) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2008-08-14 |