| NPI | 1538273305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD CR000676) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD RO36615) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2012-02-15 |