| NPI | 1023011574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA990) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA 090352) |
| Enumeration Date | 2005-05-28 |
| Last Update Date | 2015-10-12 |