| NPI | 1386663821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 089007059CRNA) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR 41175) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2010-10-25 |