| NPI | 1811990815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 047468) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 098705) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2009-08-04 |