| NPI | 1417036419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 19619) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R852840) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2016-05-31 |