| NPI | 1043264864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: AL RN080277) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP04032) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2011-11-18 |