| NPI | 1255508412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD AC001450) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 145607-30) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 13676) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 182305) | |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2015-03-31 |