| NPI | 1164579884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AL 1-090688) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1090688) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2007-07-08 |