| NPI | 1619046125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 100698) |
| Additional Taxonomies | 174400000X Specialist (Licence: NE 100698) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2012-03-07 |