| NPI | 1619063914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0001207275) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 045353) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2014-01-29 |