| NPI | 1649207663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD R022141) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9208984) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SD CR000202) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2012-01-17 |