| NPI | 1407811896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA-01096) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT RN25707) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2011-11-08 |