| NPI | 1457400137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP60326666) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 43667) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2014-11-25 |