| NPI | 1962672915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 078679) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 714039) |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2009-07-30 |