| NPI | 1386998557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 101338) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 625999) |
| Enumeration Date | 2012-11-09 |
| Last Update Date | 2016-04-13 |