| NPI | 1336321405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC CRNA37309) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC APRN372) |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2011-05-11 |