| NPI | 1255391629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR R82661) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 1028924887) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2012-02-10 |