| NPI | 1811217292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 4477) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 083935) |
| 163W00000X Registered Nurse (Licence: PA 56619) | |
| 367H00000X Anesthesiologist Assistant (Licence: CT 004477) | |
| Enumeration Date | 2010-06-08 |
| Last Update Date | 2012-09-28 |