| NPI | 1114190162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101030) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D115455) |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2010-02-19 |