| NPI | 1568442010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 148720) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN180094 CRNA) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2008-03-03 |