| NPI | 1629273735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 190408) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC APRN3271) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2014-05-01 |