| NPI | 1215979463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 4055) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 3293) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9298728) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2016-04-14 |