| NPI | 1285689521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 128409) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME R046483) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2012-07-31 |