| NPI | 1043274996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN212877) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP04381) |
| Enumeration Date | 2006-04-16 |
| Last Update Date | 2014-09-25 |