| NPI | 1235171539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R100327) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 137649) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2011-05-09 |