| NPI | 1427398890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 2292951) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R197910-1) |
| Enumeration Date | 2013-02-22 |
| Last Update Date | 2014-09-29 |