| NPI | 1629186119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO SRA-25006) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD R029252) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D098459) | |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2010-09-21 |