| NPI | 1154331510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP1678092) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ARNP 1678092) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2009-06-09 |