| NPI | 1386658953 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA RN034661)  | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP02011)  | 
| Enumeration Date | 2006-07-28 | 
| Last Update Date | 2015-01-06 |