| NPI | 1962593913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TN 138393) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 661322) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 73432) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 3355) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2007-07-08 |