| NPI | 1568456093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD RO14728) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WY 12580.0880) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2010-01-21 |