| NPI | 1891836748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NC 057610) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 29140) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2007-07-09 |