| NPI | 1225085616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 084325) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 03641) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2018-06-20 |