| NPI | 1629078878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 285765) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP 9263613) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2008-05-16 |