| NPI | 1346658572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R183408) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 689365) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2015-09-30 |