| NPI | 1083870042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT 56474) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ crna0580) |
| Enumeration Date | 2008-07-30 |
| Last Update Date | 2014-02-08 |