| NPI | 1497941959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R149207) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD R149207) |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2015-03-03 |