| NPI | 1912983214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024156458) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001156458) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2013-09-30 |