| NPI | 1467603456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2260047) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 072909) |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2010-10-26 |