| NPI | 1245229640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D140600) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 100838) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH COA.11621-NA) | |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2016-03-08 |