| NPI | 1134486228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101206) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 64148) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D-130496) | |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2013-05-08 |