| NPI | 1174666721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D108808) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: HI RN-60337) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2009-11-09 |