| NPI | 1962793513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101168) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 53115443102) |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2011-12-23 |