| NPI | 1396737318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC APRN 2120) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 045698) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2013-03-28 |