| NPI | 1114035631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 100510) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D 070551) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2017-04-05 |