| NPI | 1003804147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO CRA-1218) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 81449) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2011-07-14 |