| NPI | 1043419997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA01061) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 3209) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2010-02-11 |