| NPI | 1629076732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 1019) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 138634) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2010-12-21 |