| NPI | 1982696043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D-097433) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IA DO53141) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2010-06-29 |