| NPI | 1023166410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 139810) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 26721) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |