| NPI | 1528061942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VT 1010091185) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 043575-23-11) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2013-02-11 |