| NPI | 1508816497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 523406) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME R045040) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2012-09-11 |