| NPI | 1508819855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0363) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WA AP30007321) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: VT 101.0086894) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2012-11-20 |