| NPI | 1639151673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-037486) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R863153) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2009-03-24 |