| NPI | 1619942497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP04869) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR CO2643) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2007-07-08 |