| NPI | 1053536359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD CR000655) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD R030453) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2013-01-03 |