| NPI | 1174890438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0001202139) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: DC RN1016945) |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2011-11-30 |