| NPI | 1851611016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA 084670) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN 02769) |
| 163W00000X Registered Nurse (Licence: PA RN 590080) | |
| 163W00000X Registered Nurse (Licence: CA RN 650968) | |
| 163W00000X Registered Nurse (Licence: CA RN 357922) | |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2010-06-28 |