| NPI | 1982617015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 073896) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 205113) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2011-12-27 |