| NPI | 1306810221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA2840) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD 0144) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D103511) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2016-06-01 |