| NPI | 1922258292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 80528) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 186941) |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2015-04-03 |