| NPI | 1972672442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 677279) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9219382) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 586582) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN580473) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2011-06-15 |