| NPI | 1477543460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 9983) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 103828) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2010-08-12 |