| NPI | 1053577940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP05548) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: LA AP05548) |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2009-02-26 |