| NPI | 1336180025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28056649A) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 28056649A) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2011-10-06 |