| NPI | 1104863240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D-053906) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD R014513) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2010-07-12 |