| NPI | 1023016581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1080417) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 180519) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2008-02-20 |