| NPI | 1417292483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN 596093) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NR15007100) |
| Enumeration Date | 2012-12-03 |
| Last Update Date | 2014-02-28 |