| NPI | 1215993035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 547294) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 1641) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2008-01-26 |