| NPI | 1649202813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R179929) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: DC RN1002613) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2010-06-15 |