| NPI | 1154495497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 185171) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: RI RNA18913) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2010-03-01 |