| NPI | 1255428439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 100507) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D-067145) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2012-04-19 |