| NPI | 1396076808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 4132) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 696926) |
| Enumeration Date | 2010-01-22 |
| Last Update Date | 2012-06-19 |