| NPI | 1265641310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D134055) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R158640) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2013-10-03 |