| NPI | 1912082215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 071621) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 194328) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2012-07-02 |