| NPI | 1184848319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: HI 31815) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: HI 25300) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2007-10-15 |