| NPI | 1831519123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 104650) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 252411) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2014-10-15 |