| NPI | 1962760744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 90167) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 6210911-3102) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2015-07-07 |