| NPI | 1265490577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D092683) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 084499) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2010-02-11 |