| NPI | 1366479966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 2119602) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024165852) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 129403) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2008-10-07 |