| NPI | 1083642888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024167993) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 70535) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2008-11-21 |