| NPI | 1073815445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L6-0A00604) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN602279) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ00308900) | |
| Enumeration Date | 2010-11-17 |
| Last Update Date | 2011-06-22 |