| NPI | 1013917095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 2451) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID N013871-RNA-127) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2010-06-03 |