| NPI | 1962655902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9198350) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9198350) |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2014-01-02 |