| NPI | 1255496493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID RNA690) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT RN26353) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2015-05-13 |