| NPI | 1225297724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R30191) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD CR000703) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2014-05-15 |