| NPI | 1396036653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2287250) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L1-0027287) |
| Enumeration Date | 2011-04-21 |
| Last Update Date | 2014-05-14 |