| NPI | 1669415626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 9162) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 55790) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2015-11-06 |