| NPI | 1437160454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VT 1010060781) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 0321772311) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2011-02-04 |