| NPI | 1619906336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D078551) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD R030050) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2012-06-22 |