| NPI | 1619980943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024169114) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA RN597405) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA3306) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2014-04-29 |